Single patch multilayer aortic annular repair for destructive infective endocarditis.

Active infective endocarditis may progress to annular abscess formation. We describe a patch annuloplasty technique to treat the fragile aortic root tissue in these patients.

"Frozen Apex" Repair of a Dilated Cardiomyopathy.

We try to make surgical ventricular restoration simpler and more adjustable to safely enhance ventricular function. In eight patients with DiDonato type III dilated cardiomyopathy, we applied a few short-axis purse-string sutures to the endocardial side of the left ventricular apex ("Frozen-Apex" restoration) to make a smaller, cone-shaped apex, based on the concept that the left ventricular apex is important in its existence, but not in its function. The procedure took less than 15 minutes in all the patients. There was no hospital or late death with the follow-up of 549 ± 389 days. Mid-late postoperatively, New York Heart Association functional class changed from 3.5 ± 0.8 (preoperative) to 1.6 ± 0.6 (P = 0.000 vs preoperative), left ventricular diastolic diameter from 64 ± 16 to 61 ± 15 mm, systolic diameter from 57 ± 15 to 50 ± 17mm (P = 0.070), ejection fraction from 27 ± 10 to 40 ± 16% (P = 0.014). Diastolic function as assessed by the ratio of the early to late ventricular filling velocities, the ratio of mitral annular early diastolic velocity to early mitral inflow velocity, and estimated right ventricular pressure remained at the similar level to preoperative one. The new ventricular restoration was associated with better systolic left ventricular function without deteriorating diastolic one. It may improve the outcome of the treatment of selected patients with dilated cardiomyopathy.

Epicardial 15-MHz Echocardiography for Effective Repair of Coronary Arteriovenous Fistula.

In the era of catheter intervention, the surgical repair of coronary arteriovenous fistula needs to be free from residual shunt. Intraoperative epicardial 15-MHz echocardiography helps to find the residual shunt after ligation or obliteration of anomalous vessels. Here we report our method of the echo-assisted surgical repair of coronary arteriovenous fistula in 7 adult patients. The method made the operation for coronary arteriovenous fistula free from residual shunt, but care should be taken to the development of new vessels after the operation.

Spontaneous Evacuation of a Vascular Metallic Stent through a Graft-Duodenal Fistula with Concomitant Non-Surgical Fistula Closure.

We report a patient who developed ileus caused by vascular stent migration into the duodenum with periprosthetic retroperitoneal abscess. The patient previously underwent removal of an infected abdominal aortic aneurysm with concomitant axillobifemoral arterial reconstruction. An occlusion of the graft leg was treated by a unilateral aortoiliac bypass where endovascular surgery with a metallic stent was later needed. The abscess and ileus were vigorously drained. Following the spontaneous evacuation of the metallic stent via the digestive tract, the abscess was completely drained and fistula closure was achieved without surgical intervention. The patient has remained healthy 6 years thereafter.

The Effect of Hachimi-Jio-Gan (Ba-Wei-Di-Huang-Wan) on the Quality of Life in Patients with Peripheral Arterial Disease - A Prospective Study Using Kampo Medicine.

Objective: To assess whether Hachimi-jio-gan (HJG), a preparation of Kampo medicine (traditional Japanese medicine), improves quality of life (QOL) in patients with peripheral arterial disease (PAD). Materials and Methods: Among the patients with PAD being followed in the Department of Cardiovascular Surgery at Tokyo Medical University Hachioji Medical Center, those with intermittent claudication (IC) and in stable condition regarding PAD severity were registered. We registered the patients from April 2014 to March 2015. We administered HJG extract for 6 months to the patients. The primary endpoint was Walking Impairment Questionnaire (WIQ) score, which was approved as an indicator of QOL of the patient with PAD. We assessed WIQ score both before and after administration of the HJG. Results: We analyzed 14 patients. WIQ items of pain, distance, and speed improved significantly. Furthermore, the median of the total score of WIQ improved significantly from 162.5 points to 308.0 points. All patients showed improvement in the total score and 7 patients out of 14 patients (50%) showed a remarkably effective improvement in score of more than 100 points. Conclusion: HJG might improve the QOL in patients with IC due to PAD.

Report of simultaneous off-pump CABG and modified mastectomy.

The patient was a 75-year-old female who had received medical treatment for effort angina. Recently, she noticed a left breast tumor, which was diagnosed as breast cancer with axillary lymph node swelling. Coronary angiography performed prior to the surgery for the breast cancer showed 90% stenosis in segment 6 of the left anterior descending artery (LAD). Coronary intervention was not possible due to anatomical reasons, so she was admitted for simultaneous surgery for the breast cancer and angina. The chest was opened through a median sternotomy and the full-skeletonized right internal thoracic artery was grafted on the LAD without cardiopulmonary bypass. A transverse elliptical incision was made after the median sternotomy was closed, and the breast tumor and lymph nodes around the subclavian and axillary vessels were completely dissected. Even in the case of multiple vessel coronary disease, simultaneous surgery may be possible, but indications should be carefully assessed considering the cardiac function and general condition of the patient.